Medicare Segment Manager

company • City of Utica, NY

6d • $79,068 - $142,322

About The Position

Under the general direction of Assigned Management, the Medicare Segment Manager supports Medicare line-of-business strategy and execution. The position ensures Medicare products and programs are administered according to approved benefit designs, regulatory requirements, and strategic objectives, and is accountable for associated service and operational requirements. The incumbent is expected to be knowledgeable about Medicare Advantage, Medicare Supplement, Part D Prescription Drug Plans, and Dual Eligible products.

The role develops and implements business plans, evaluates market opportunities and operations, supports regulatory compliance, and identifies opportunities to improve processes, efficiency, and customer experience. It collaborates across departments and with business partners to align Medicare strategies and operations, may serve as a regulatory liaison, and provides Medicare subject-matter expertise to teams across the company. The position requires maintaining current knowledge of Medicare regulations and market dynamics, safeguarding member privacy, and demonstrating the company’s mission, values, and standards of integrity. Regular and reliable attendance is expected; other duties may be assigned by management.

Requirements

• Bachelor’s degree in health administration, marketing, business administration, or a related field.
• At least six years of progressive health plan operations experience.
• Strong leadership and/or management experience.
• Strong expertise and background working with regulatory and accreditation agencies, including NCQA, CMS, federal and state agencies, and the Department of Health and Department of Financial Services.
• Maintain current knowledge of relevant regulatory requirements.
• Strong process and program management skills, analytical ability, creativity, and initiative in problem solving and solution identification.
• Strong facilitation and follow-through skills.
• Project management experience.
• Critical-thinking ability and effective negotiation skills when dealing with middle and senior management.
• Self-motivated and able to work independently without detailed direction at times.
• Strong computer skills, including Microsoft Word, Excel, and PowerPoint.
• Demonstrated analytical ability, strategic thinking, creativity, positive attitude, strong work ethic, and effective communication skills.
• Ability to establish effective relationships with representatives at all levels throughout divisions, including senior management, to execute cross-divisional initiatives.
• Ability to travel across health plan service regions as needed.

Responsibilities

• Develop strategic, operational, and tactical business plans to achieve Medicare line-of-business goals.
• Evaluate new market opportunities, including developing necessary business cases.
• Assess operations to identify root causes of problems contributing to noncompliance and customer dissatisfaction.
• Consult with team members and stakeholders to streamline systems and processes and improve effectiveness and efficiency.
• Plan, develop, and implement projects and initiatives supporting line-of-business objectives, product and benefit administration, regulatory requirements, process improvement, efficiency, and customer experience.
• Encourage innovation, process improvement, and personal development in business areas supporting Medicare products.
• Develop and maintain enterprise relationships to promote consistent strategic priorities.
• Serve as a regulatory liaison to NYS, CMS, or BCBSA as needed.
• Collaborate with cross-functional business and project teams to align with line-of-business objectives, compliance, operational performance, and process improvement.
• Integrate Medicare strategies with internal areas including Marketing, Operational Excellence, Population Health Engagement, Finance, Provider Contracting, Compliance, and Enterprise Information Technology; represent Medicare on relevant committees and projects.
• Manage maintenance of business process work-item deliverables and participate in forums and activities to solicit direct customer feedback.
• Read and interpret complex government regulations and identify necessary next steps.
• Identify issues and solve problems to address potential improvement opportunities.
• Provide Medicare subject-matter expertise to business teams on initiatives and activities affecting the line of business.
• Respond quickly to changes and challenges in the regulatory environment.
• Work with other departments to gather input, integrate perspectives, and develop processes and timelines for planning and executing strategies across departments.
• Monitor evolving Medicare market dynamics, connect trends to line-of-business objectives, and keep key business partners informed.
• Support the Lifetime Healthcare Companies’ mission and values, adhere to the Corporate Code of Conduct, and lead according to the Lifetime Way values and beliefs.
• Protect member privacy in accordance with corporate privacy policies and procedures.
• Maintain regular and reliable attendance and perform other functions as assigned by management.
• Travel across health plan service regions as needed.

Benefits

• Group health and/or dental insurance may be available as part of the total rewards package.
• Retirement plan may be available as part of the total rewards package.
• Wellness program may be available as part of the total rewards package.
• Paid time away from work may be available as part of the total rewards package.
• Paid holidays may be available as part of the total rewards package.
• Potential opportunities for remote work are considered on a case-by-case basis.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager